- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $213.80
| Facility | | $74.13 | $102.33 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $245.47 / $446.68
| Facility | 25 | $57.54 | $245.47 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $89.13 / $223.87
| Professional | | $48.98 | $89.13 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $51.29 / $93.33 / $245.47
| Professional | 25 | $51.29 | $93.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $257.04 / $269.15
| Professional | 50 | $38.02 | $257.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $100.00 / $173.78
| Professional | | $57.54 | $100.00 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $177.83
| Professional | 25 | $70.79 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $194.98
| Professional | | $89.13 | $125.89 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $117.49 / $147.91
| Facility | | $102.33 | $117.49 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | 22 | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Facility | 62 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.23
| Facility | AS | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $95.50 / $199.53
| Professional | | $47.86 | $95.50 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $77.62 / $169.82
| Facility | | $45.71 | $77.62 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $162.18
| Professional | | $45.71 | $75.86 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $100.00
| Professional | | $32.36 | $45.71 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $181.97
| Facility | | $95.50 | $151.36 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $117.49 / $223.87
| Professional | | $85.11 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $190.55
| Professional | | $89.13 | $125.89 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $213.80
| Facility | | $32.36 | $43.65 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $162.18
| Professional | | $57.54 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $151.36
| Professional | 25 | $60.26 | $89.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $97.72 / $138.04
| Professional | | $57.54 | $97.72 | $138.04 |